How Long Does It Take to Get a Decision on Workers’ Compensation Claims?

Workers’ Compensation

When you’re injured at work and waiting for a decision on your workers’ compensation claim, you may worry. You might wonder how you will pay your bills and take care of your family. It may feel as if the process takes far too long. However, remember that every state has specific timelines, deadlines, and operational guidelines when it comes to workers’ compensation. Learning more about this process can help you manage your expectations.

The Initial Claim

Every state requires workers to report an on-the-job injury to the employer within a specified period to be considered for workers’ compensation benefits. Some states also require you to file a claim with a particular state agency to start the claims process. Notice provisions and claims methods vary by state. Failure to follow them can mean losing your benefits, so it’s in your best interest to seek counsel from a workers’ compensation attorney, like a New Jersey workers’ compensation attorney, as early as possible in the process.

The Investigation Process

Once the claim is successfully filed, the decision-making entity opens an investigation. The process includes interviews with you and your employer, as well as a review of your medical records and other relevant accident reports and documents. As long as the requests for information are reasonable, you should comply to keep the process moving along. However, if you feel the demands are becoming intrusive, contact an attorney for guidance.

The Initial Decision to Approve or Deny

Every state except Texas requires employers to carry workers’ compensation coverage for their employees. Businesses can usually choose to purchase a workers’ compensation policy through a private company or to apply to be self-insured. Other states offer a workers’ compensation fund that companies can buy into for coverage. Therefore, the initial decision to approve or deny your workers’ compensation claim belongs to one of three parties.

  • The claims administrator at an insurance company
  • Your company (or its third-party designee) if it is self-insured
  • A government agency tasked with handling workers’ compensation claims for business in the state pool

Regardless of the entity, you are entitled to a decision in a reasonable time. Most states require the administrator to give you a decision within 30 days. However, some states allow for an extension if the investigation requires one. In some states, insurance companies face financial penalties if they fail to respond in a timely manner. In others, your claim is automatically approved if not denied within the time limit.

When to Get Help

If at any point your employer or the insurance company becomes unresponsive or unreasonable, contact a knowledgeable and experienced workers’ compensation attorney, like a New Jersey workers’ compensation attorney, to help you walk through the process. This is the best way to protect yourself and safeguard your rights.

Thanks to Rispoli & Borneo, P.C. for their insight into how long it typically takes to hear a decision on a workers’ compensation claim.